Chest wall paresthesia affects a significant but previously overlooked proportion of patients following sympathectomy

 "Paresthetic discomfort distinguishable from wound pain was described by 17 patients (50.0%). The most common descriptions were of ‘bloating’ (41.2%), ‘pins and needles’(35.3%), or ‘numbness’ (23.5%) in the chest wall. The paresthesia resolved in less than two months in 12 patients (70.6%), but was still felt for over 12 months in three patients (17.6%). Post-operative paresthesia and pain did not impact on patient satisfaction with the surgery, whereas compensatoryhyperhidrosis in 24 patients (70.6%) did (P=0.001). The rates and characteristics of the paresthesia following needlescopic VATS are similar to those observed after conventional VATS. Conclusions: Chest wall paresthesia affects a significant but previously overlooked proportion of patients following needlescopic VATS."

Eur J Cardiothorac Surg 2005;27:313-319"

The physiology of the sympathetic innervation of the limbs according to the ganglia and their location in correspondence with the ribs is highly variable

The Surgical Treatment of Hyperhidrosis - The Annals of Thoracic Surgery: "The physiology of the sympathetic innervation of the limbs according to the ganglia and their location in correspondence with the ribs is highly variable. Surgery performed by rib count is not anatomical, and rib count is often erroneous: according to Chou and colleagues [3], the estimated rib level was wrong in 5 of 114 patients. "



http://www.annalsthoracicsurgery.org/article/S0003-4975(11)02260-0/fulltext#bib3_internalLink

although producing no alterations in the thermal balance, does produce abnormalities in quantitative distribution of thermoregulatory sweating

JNS - Journal of Neurosurgery -: "The data demonstrate that the surgical removal of both the T-2 and the T-3 ganglia, although producing no alterations in the thermal balance, does produce abnormalities in quantitative distribution of thermoregulatory sweating in man."

the severity of post-sympathectomy (post-SE) dysfunction is unpredictable

"The aim of this study was to identify retrospectively, lumbar sympathectomy (SE) using thermography (TG) and to evaluate clinically, the severity of post-sympathectomy (post-SE) dysfunction after anterior and lateral lumbar interbody fusion procedures (ALIF, XLIF).
METHODS:
Twenty eight patients with suspected SE were referred for TG to both legs. They completed our questionnaire on severity of difficulties after SE. We evaluated the ability of physical examinations to reveal the SE in contrast to TG and compared the symptoms (warmer leg and inhibited leg sweating) of SE with questionnaire responses as subjective measure and TG as objective measure.
RESULTS:
SE was diagnosed in 0.5% after ALIF at L5/S1, in 15% after ALIF at Th12-L5 and in 4% after XLIF at T12-L5. SE severely reduced the quality of life in two cases. The ability to distinguish differences in leg temperature by palpation after SE was found in 32%. All physical examinations together were insufficient for reliably disclosing SE. Subjective symptoms of SE were often false positive and proven SE by TG was often a clinically false negative.
CONCLUSION:
This is the first study to examine post-SE dysfunction objectivelya using TG after ALIF and XLIF, and the first to evaluate clinically, the severity of the post-SE syndrome. Before surgery we cannot foresee potentially poor SE results. For this reason, injury to the sympathetic chain during surgery must be avoided. The advantage of TG for identifying SE is its non-invasiveness and reliability.
http://www.ncbi.nlm.nih.gov/pubmed/24263213"

most of the existing literature is geared towards assessing only the effectiveness of the surgical sympathectomy

"Given the fact that most of the existing literature is geared towards a) assessing only the effectiveness of the surgical sympathectomy procedures, and b) publishing only studies with positive results, adverse effects and complications are not systematically reported but rather as a secondary outcome. It seems, therefore, highly likely that the complications as reported here, are truly underestimated.



The study indicates that surgical sympathectomy, irrespective of operative approach and indication, may be associated with many and potentially serious complications."  



Are We Paying a High Price for Surgical Sympathectomy? A Systematic Literature Review of Late Complications

http://www.jpain.org/article/S1526-5900%2800%2944124-6/abstract

33% of patients reported compensatory hyperhidrosis that was either 'severe' or 'incapacitating'

Endoscopic thoracic sympathectomy for primary hyperhidrosis of the...IPG487 Safety: "Compensatory hyperhidrosis was reported in 92% (416/453), 86% (1720/2000) and 74% (1265/1700) of patients in 3 case series. In 2 of these studies 33% (557/1700 and 150/453) of patients reported compensatory hyperhidrosis that was either 'severe' or 'incapacitating'."